Background The advantages of transradial neuroangiography over a transfemoral access with respect to fewer access site complications, shorter procedure duration and better patient comfort are well described. Radial arterial lines are routinely placed in the ICU in critically ill neurosurgical patients and in the OR on patients undergoing complex neurovascular procedures. We describe the utility of rewiring a radial arterial line in exchange for an arterial sheath for the purpose of diagnostic cerebral arteriography or neurointervention. Rewiring a radial arterial line has the practical benefit of avoiding repeat needle puncture in the setting of an existing catheter that can be ready exchanged for an arterial sheath using a wire exchange technique.
Methods Consecutive patients who had transradial neuro-angiography through arterial line access over the 12 months were included in the study. The technique for transradial access was modified in the presence of arterial line. The Arterial line catheter was re-wired and exchanged with 5Fr or 6 Fr sheath as necessary. Data on demographics, indication, devices, and complications was recorded and analyzed.
Results Twelve procedures were performed on 11 patients. Mean age was 58.6 +12.9 years; 7 were female. Seven procedures were performed using left-sided arterial line access while 5 procedures were performed using the right side. The most common indication was post-operative angiogram after clipping of aneurysms (n=8), coiling of anterior communicating artery aneurysm (n=1), arteriovenous fistula surgery (n=1). Two cases were performed to evaluate intraventricular hemorrhage (n=1), and arteriovenous malformation resection (n=1). No access site complication was observed. The radial artery sheath was either removed or sutured in place to be used as an arterial line if the patient needed to return to the operating room or the ICU.
Conclusion Arterial line rewiring allows rapid transradial access with an arterial sheath and avoids repeat needle puncture. This improvised approach to transradial interventions is especially useful for immediate post-operative evaluation of vascular disorders.
Disclosures R. Dossani: None. M. Waqas: None. M. Tso: None. G. Rajah: None. H. Rai: None. A. Levy: None. A. Siddiqui: None. J. Davies: None.
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